Provider Demographics
NPI:1437444866
Name:SWEENEY, KEVIN C (MD, DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 COUNTRY CLUB RD STE 100
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6045
Mailing Address - Country:US
Mailing Address - Phone:541-465-3939
Mailing Address - Fax:541-465-3946
Practice Address - Street 1:911 COUNTRY CLUB RD STE 100
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6045
Practice Address - Country:US
Practice Address - Phone:541-465-3939
Practice Address - Fax:541-465-3946
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD105481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery